Join Cteen

Please fill out this form to sign up for CTeen S.Monica so we can keep you in the loop of all that we have going on. Feel free to send this to any Jewish teen you think may be interested.
TEEN:
Full Name*
First Name Last Name
Mobile Number*

Area Code Phone Number
Personal Email*
Date of Birth*

Month Day Year
Hebrew Name:*
School*
Grade*

9th10th11th12th

Address*

Is the natural father of teen Jewish?**
Is the natural mother of teen Jewish?**
Have there been any conversions in the family?**
Please let us know about any allergies or other medical concerns we should be aware of.
Who did you hear about CTeen S.Monica from?
PARENTS:
Mother's Info
Mother's Full Name*
First Name Last Name
Mobile*

Area Code Phone Number
E-mail*
Marital Status of parents

MarriedDivorcedOther
Father's Info
Father's Full Name
First Name Last Name
Mobile

Area Code Phone Number
E-mail
Help us cover our costs for Cteen S.Monica events and programs and become a committed member of our CTeen family. No one will be turned away due to lack of funds.
Cteen S.Monica Program

$360- Committed Member (Perks include- All local chapter & regional events/trips free. $25 off NYC Shabbaton)I am excited to join Cteen S.Monica and join/pay per individual events.Chai Club-Create a continuous source of “Chai – life” for Cteen S.Monica community with a monthly donation.

Payment

Credit Card Cash

Postal / Zip Code

Country

I am aware that by participating in Cteen S. Monica and its programs I consent to having my child's pictures being used in any media produced by publicity purposes or otherwise.

Yes
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TEEN: